New contralateral vesicoureteral reflux after endoscopic correction of unilateral reflux--is routine contralateral injection indicated at initial treatment?

PURPOSE: As more and more pediatric urologists use endoscopic therapy as a primary treatment option for vesicoureteral reflux, newer indications for this procedure are being considered. Recently it was suggested that contralateral nonrefluxing ureters should be treated prophylactically in patients undergoing unilateral endoscopic correction of vesicoureteral reflux. We analyzed the incidence of newly diagnosed contralateral reflux after endoscopic correction of unilateral reflux and identified possible risk factors for its development.

MATERIALS AND METHODS: Between 1996 and 2004, 662 patients underwent endoscopic correction of unilateral grades II to V vesicoureteral reflux. Of the ureters 97% had grades III to V reflux. The tissue augmenting substance used for endoscopic treatment was polytetrafluoroethylene from 1996 to 2000 and dextranomer/hyaluronic acid from 2001 to 2004. There were 203 males (30.7%) and 459 females (69.3%) with an age at endoscopic treatment of 2 months to 11 years. Voiding cystourethrograms performed 3 months after endoscopic treatment of unilateral vesicoureteral reflux were analyzed in all patients to document newly diagnosed contralateral reflux.

RESULTS: A total of 67 children (10.1%), including 18 boys and 49 girls, showed new contralateral reflux on voiding cystourethrogram after endoscopic correction of unilateral reflux. Contralateral VUR was grades I to IV in 16 (23.9%), 17 (25.4%), 27 (40.3%) and 7 patients (10.5%), respectively. There was no correlation between the severity of ipsilateral reflux and the development of contralateral reflux. Patient age and gender did not influence the development of new contralateral reflux.

CONCLUSIONS: The low incidence and lower grade of newly diagnosed contralateral vesicoureteral reflux after endoscopic correction of unilateral reflux does not support prophylactic treatment of nonrefluxing contralateral ureters.